W03 - PSYCH: Child & Adol. Psych; Eating Disorders; Personality Disorder Flashcards

1
Q

Distinguish between the different eating disorders as well as between eating disorders and ‘feeding disorders’, and demonstrate awareness of the range of symptoms and behaviours involved.

A
  • highest mortality rate amongst psychiatric symptoms
  • all share features of pre-occupations

BULIMIA NERVOSA
* eating large amounts of food with a loss of control over the eating — and then purge, trying to get rid of the extra calories in an unhealthy way.
* purging Vs non-purging

ANOREXIA NERVOSA
* Relies on compulsive compensatory behaviours when food cannot be avoided, Self induced vomiting, laxative abuse, excessive exercise, abuse of appetite suppressants / diuretics.

BINGE EATING DISORDERS
* repetitive cycles, similar to bulimia nervosa with nil purging, ‘buzzed’ after eating

  • Other specified feeding or eating disorder (OSFED)

*Avoidant Restrictive Food intake disorder. ( ARFID)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Analyse the predisposing, precipitating and perpetuating factors contributing to the onset of eating disorders.

A

*obsessive fear of fatness, avoidance food and sources of calories

PREDISPOSING:
high risk obsessionality
genetic
perinatal

PRECIPITATING:
life events - trauma
puberty
dieting
exercise

PERPETUATING:
consequences of starvation syndrome
- delayed gastric emptying
- narrowing focus
- obsessionality
- high emotional expression: families, school, clinic staff

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Describe evidence-based treatments for the management of the different disorders

A
  • specialist centres associated with lower mortality rates
  • Average time for recovery from anorexia nervosa – where this occurs – has been estimated at 6 – 7 years.

> Re-feeding = vital in ensuring good response to medication and psych. support and intervention

> Psych. Support & Rx.
CBT-ED
MANTRA
SSCM
CBT + self-help

> IPT, fluoxetine

> Olanzapine

> Family work

+ Dietary advice and education
+ Medicine for psychological symptoms
+ bone health

  • follow-upss
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Demonstrate the use of motivational approaches and the technique of ‘externalising the disorder’.

A

*motivational and open approach to combat feeling of isolation.

*controlling impulses => from EXTERNALISING DISORDERS (vs INTERNALISED)

  • Externalizing disorders are often specifically referred to as disruptive behavior disorders (attention-deficit/hyperactivity disorder, oppositional defiant disorder, and conduct disorder) or conduct problems which occur in childhood. Externalizing disorders, however, are also manifested in adulthood. For example, alcohol- and substance-related disorders and antisocial personality disorder are adult externalizing disorders.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Manage risk of death and of irreversible physical damage appropriately in patients with severe eating disorders

A
  • assessment of risk of profound electrolyte disturbance
  • severe wt loss
  • <40bpm
  • severe dehydration; fluid refusal
  • hypothermic
  • prolonged QT complex
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Prioritise nutritional concerns in the management of the mental and physical health of all patients, whether or not they have formal eating disorders

A

> Re-feeding = vital in ensuring good response to medication and psych. support and intervention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

TIDE

A

DM with eating disorder

  • insulin omission

*food restricition A/nervosa variant
- CHO avoidance/restriction

  • binging/bulimic variant
  • intentional insulin omission
    = ketoacidosis high risk
  • Diabetes Eating Disorder Survey – Revised DEPS- R . 16 item questionnaire, diabetes specific , self-reported measure of disordered eating
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Anx. Nervosa Signs & Symptoms

A

cold intolerance: peripheral wasting, dt cardiac muscle weakening = maintenance of core.

blue hands feet

GI bloating / constipation

delayed puberty, Primary or secondary
amenorrhea

dry skin

fainting

fatigue, weakness

haair symptoms

Osteopenia & osteoporosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Bulimia Nervosa Signs & Symptoms

A

Pharyngeal trauma

esoph rupture

dental caries, mouth sores

Heartburn, chest pain

impulsivity

Muscle cramps
Weakness
Bloody diarrhoea
Irregular periods
Fainting
Swollen parotid glands
hypotension

*K+ loss = cardiac arrhythmia risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Link to anorexia nervosa and reynauds

A

some may come in to mask their anorexia nervosa = low wt, peripheral wasting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

To be able to discuss the impact of genetics, family and the wider social environment on the development and maintenance of psychiatric disorder in young people.

A

*early life hx, genogram significance, personal hx etc.
+ temperment, likes/dislikes
+ in-utero stress = LT dmg
+ collateral hx

PREDISPOSING
* genetics, toxic in-utero, birth compl., insult

PRECIPITATING
* iatrogenic rection, substance misuse
* new stress
* school/home changes = stress

PERPETUTATING
* poor response to meds, pain, illness
* personality, coping, self-belief, world outlook

PROTECTIVE
* diet, sleep, genes, exercise, intelligence
* cognitive strategies, coping, psychologically minded
* faith, community, family

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

To recognise the features of the common psychiatric disorders that affect young people.

A

a

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

To be aware of the impact that child psychiatric disorder may have on normal developmental processes, the family and later adult life.

A

a

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

ADHD features and mgmt

A
  • 6 months inattention and/or hyperactivitity-impulsivity
  • present before 12, M>F
  • hyperactive-impusive symptoms recede vs persisting inattention

= functional negative impact

  • Conners index

(1)
> parent training programme
+ school adjustments

(1)
> Methylphenidate
2. >Lisdexamphetamine
3. >Atomoxetine (non-stimulants)

  • monitor growth, baaseline obs, cardiac events hx
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Autism Spectrum Disorder features and mgmt

A
  1. IMPAIRMENTS IN RECIPROCAL SOCIAL INTERACTIONS
  2. DIFFICULTIES WITH SOCIAL COMM
  3. RESTRICTED, REPETITIVE, INFLEXIBLE PATTERNS OF INTEREST / BEHAVIOUR

*early childhood
= impaired functioning
+ impaired functionl language, intellectual dev.

M>F

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Psychometrics for anxiety in children

A

The Revised Child Anxiety and Depression Scale (RCADS)

CHILDREN’S YALE-BROWN OBSESSIVE COMPULSIVE SCALE (CY-BOCS)

16
Q

Mgmt for Anxiety in Children

A

> School based intervention frequently

> CBT, Graded exposure, Exposure response prevention, SLT, OT, Physio as appropriate

> SSRI can be considered if inadequate response

17
Q

Mediating mechanisms vs Moderating mechanisms

A

Mediating mechanisms = processes accounting for familial factors that attribute to child’s risk for psychopath.

Moderating mechanisms = who and when is the greatest risk..ID populations at risk and can focus on.

18
Q

To understand the nature and epidemiology of personality disorder

A

Lifelong, persistent, deeply ingrained maladaptive behaviour that:
- characterizes an individual
- deviates markedly from culturally expected or accepted ‘normal’ range
- Onset in late childhood or early adolescence

affecting: cognition, affectivity, social conduct, impulse/gratification control, interpersonal function

19
Q

To have an understanding of therapeutic options

A

Biopsychosocial approach
Assessment for full diagnostic picture, including co-occurring mood and addictive disorders
Diagnostic formulation, risk management planning, and setting of treatment goals and realistic ways of meeting them
Judicious use of medication
Specific psychological treatments
Social interventions

> Antipsychotics – cognitive symptoms, impulsivity and intense angry affect

> Monoamine Oxidase Inhibitors – borderline PD to alleviate abnormal mood

> Carbamazepine and lithium – episodic behavioural dyscontrol and aggression

20
Q

Borderline Pattern

A

A pattern of unstable and intense interpersonal relationships, typically characterized by alternating between extremes of idealization and devaluation. Identity disturbance, manifested in markedly and persistently unstable self-image or sense of self.